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GET HELP NOWCOASTAL_VDG_ADMIN2022-02-14T14:50:50+00:00

If you are fleeing domestic violence, please do not complete this application until you have reached out to a domestic violence provider. Call the Domestic Violence Hotline: 24hr Hotline: 1-800-334-2836

If you are currently housed and only looking for help finding new housing because your lease is up, your rent was raised, etc., do NOT complete this application. We do not provide housing search assistance. You may try georgiahousingsearch.org or sites like apartmentfinder.com.

CCES is typically unable to provide same day service. You will receive a call or email within 24 hours once you submit your application. We will make a referral to a partner agency to provide shelter, or other related services, based on availability. If resources are currently unavailable, we will let you know.

Assistance Application

Name(Required)

First Last

Age(Required)

Please enter a number greater than or equal to 0.

Phone Number(Required)

(Enter "000-000-0000" if you do not have a phone)

(Skip if you do not have access to email)

Where did you sleep last night?(Required)

Shelter

Hotel/Motel

Friend or family’s home

Park

Car

Woods or encampment

Under a bridge

Other

Other (explain in the box)(Required)

How long have you been homeless?(Required)

Less than one month

1-3 months

4-6 months

6 months or more

I mainly need help with: (only select one)(Required)

Emergency shelter

Hotel/motel voucher

Rental assistance

Mortgage assistance

Finding housing- I have a place but need help finding a new place

Something else

Something else (explain in the box)(Required)

I also need help with: (select all that apply)(Required)

Childcare

Educational attainment (get my GED, etc.)

Finding a job

Food

Identification (getting birth cert, ID card, etc.)

Clothing

Medical/Mental health

Do you have children?(Required)

Yes

How many kids are in your household?(Required)

Please enter a number greater than or equal to 0.

How many adults are in your household?(Required)

Please enter a number greater than or equal to 0.

(18 years old or older)

Are you a Veteran?(Required)

Yes

Are you Disabled?(Required)

Yes

What county are you seeking to receive services?(Required)

Phone

This field is for validation purposes and should be left unchanged.

To access the Coastal Coordinated Entry System, call 912-955-HOPE (4673), 912-275-7202 or contact one of our partnering agencies for more information.

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